PB2298: CHRONIC HEPATITIS B VIRAL ACTIVITY IS AN INDEPENDENT PROGNOSTIC FACTOR OF LYMPHOMA
Authors: Ho Sup Lee, Jae-Cheol Jo, Da-Jung Kim
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: About 350 million people worldwide are estimated to be infected by the hepatitis B virus (HBV), and 600,000 deaths annually can be attributed to chronic hepatitis B (CHB). HBV infection carries a risk of extrahepatic malignancy. A typical extrahepatic malignancy associated with HBV is malignant lymphoma (ML). Because the prevalence of HBV is high in Asia, the number of ML patients with HBV is likely to increase in the future. Currently, CHB patients are prescribed antivirals according to guidelines based on HBV-DNA elevation and underlying liver function. In other words, antiviral treatment depends on viral activity and related liver status. After introduction of entecavir (ETV) and tenofovir (TDF), the risks of extrahepatic malignancy seem to be increasing as a result of the prolonged survivals. Aims: This study was performed to determine how HBV infection and antiviral treatment affect the development and prognosis of ML. In addition, we investigated whether ML development could be affected by the kinds of antivirals. Methods: The National Health Insurance Service (NHIS) has a comprehensive health database of both inpatients and outpatients. It includes all medical claims data for prescription drugs, codes of diagnosis and treatment, and all reimbursed medical procedures. We collected data for all CHB patients in Korea who were newly diagnosed with ML between 1 January 2002 and 31 December 2016. As a control group, we used the propensity score matching method to collect data on 10 times that number of CHB patients who did not develop ML. To compare the effects of antivirals (ETV vs. TDF) on ML development, we performed a subgroup analysis. To apply the same observation period, the follow-up durations of patients diagnosed with ML (the time taken to diagnose ML after drug administration) were randomly assigned to control patients. Results: A total of 13,942 CHB patients were newly diagnosed with ML from 2003 to 2016. The number of patients increased 3.8 times, from 442 in 2003 to 1711 in 2016. In the same period, the number of cumulative CHB patients doubled, from 320,182 to 646,273. Over time, both the number of HBV patients newly diagnosed with ML and the proportion of HBV patients newly diagnosed with ML increased. Mature B cell lymphoma increased 3.8 times, from 389 in 2003 to 1492 in 2016. Mature T cell and NK-cell lymphoma increased about 6.2 times, from 26 to 161 in that period. Hodgkin lymphoma increased 1.9 times, from 24 in 2003 to 46 in 2016. The 2-year survival rate of all patients was 76.8%, and the 5-year survival rate was 69.8%. Mature B cell lymphoma with HBV had a 2-year survival rate of 76.9% and a 5-year survival rate of 70.1%. Mature T cell and NK-cell lymphoma had a 2-year of 72.0% and a 5-year of 63.7%. Hodgkin lymphoma had a 2-year of 84.6% and a 5-year of 77.4%. The survival rate of CHB ML patients with LC at baseline was significantly lower than in those without LC and even lower in decompensation. In patients without LC, the survival rates were 1 yr—84.1%, 3 yr—73.4%, and 5 yr—68.1%. The survival rates of CHB ML patients with LC were 1 yr—77.4%, 3 yr—64.9%, and 5 yr—59.2%. The reduced survival rate in the antiviral treatment group of LC was statistically significant (HR 0.67, CI, 0.48–0.94, p < 0.022). Summary/Conclusion: the viral activity could independently influence the prognosis of ML. In addition, cirrhotic patients had a poor survival rate after a diagnosis of ML, and even worse in decompensation. Clinically, our data suggest that the kinds of antivirals did not affect the risk of ML. Keywords: Hepatitis B virus, Malignant lymphoma, Liver disease